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Risk factors for immediate complications after progressive pneumatic dilation for achalasia
E H Metman1, J P Lagasse, L d'Alteroche
1Service d'Hépato-gastroentérologie, Hôpital Trousseau, Tours, France.
The American Journal of Gastroenterology
|May 11, 1999
Summary
Progressive pneumatic dilation for achalasia has a low complication rate. Advanced age (over 90) and balloon instability during dilation are risk factors for early complications, particularly perforation during the first dilation.
Area of Science:
- Gastroenterology
- Gastrointestinal Endoscopy
- Surgical Risk Assessment
Background:
- Achalasia is a primary esophageal motility disorder.
- Pneumatic dilation is a common treatment for achalasia.
- Understanding early complications is crucial for patient safety.
Purpose of the Study:
- To identify risk factors for early complications following progressive pneumatic dilation for achalasia.
- To evaluate the safety and efficacy of this dilation technique.
Main Methods:
- Retrospective analysis of 504 dilations in 237 achalasia patients (1980-1994).
- Progressive low-pressure pneumatic dilation with increasing balloon diameter.
- Comparison of clinical, radiological, endoscopic, and manometric data between patients with and without early complications.
Main Results:
- 15 complications (6%) observed, including 7 perforations (3%).
- Higher mean age (68.5 vs 56.4 years) and balloon instability during dilation were associated with complications.
- Most perforations occurred during the first dilation; two deaths in patients >90 years.
Conclusions:
- Progressive pneumatic dilation is a low-complication technique for achalasia.
- Patients over 90 years require caution; balloon instability is a risk factor.
- Hiatal hernia, esophageal diverticulum, or vigorous achalasia do not preclude safe dilation.
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